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MSK > Orthopaedic hip conditions > Flashcards

Orthopaedic hip conditions Flashcards

1
Q

What 3 bones make up each hemipelvis?

A

Ischium
Ileum
Pubis

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2
Q

Why does the femur have high clinical significance?

A

Neck of femur fracture is very common

Bleeding from fracture

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3
Q

What is the greater trochanter?

A

Site of attachment for abductors and rotators on the femur

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4
Q

What is the lesser trochanter?

A

Site of attachment for psoas muscles

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5
Q

What is the acetabulum?

A

A socket in the pelvis that the head of the femur fits into

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6
Q

What is the labrum?

A

Fibrocartilaginous lining of the acetabulum which deepens the socket and adds stability

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7
Q

What artery supplies the hip joint?

A

Profunda femoris artery

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8
Q

What are the 2 main branches of profunda femoris?

A

Medial femoral circumflex artery

Lateral femoral circumflex artery

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9
Q

Does blood supply for the neck of femur come from within or outside the capsule?

A

Within

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10
Q

What is the clinical significance of a fracture being intracapsular?

A

Blood supply is disrupted whereas with an extra capsular fracture supply is maintianed

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11
Q

What are the 5 types of muscles around the hip joint?

A 
Flexors
Extensors
Abductors
Adductors
Rotators
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12
Q

What is the purpose of bursae?

A

Reduce the friction between tissues

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13
Q

What is osteoarthritis?

A

Progressive loss of articular cartilage with secondary bony changes caused by worsening pain and stiffness of the affected joint

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14
Q

Where is the trochanteric bursa?

A

Between hip abductors and iliotibial band

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15
Q

Are males or females more likely to get trochanteric bursitis?

A

Females

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16
Q

What can cause trochanteric bursitis?

A

Trauma
Overuse - athletes
Abnormal movement - can be caused by other problems such as scoliosis or muscle wasting

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17
Q

How will a patient present with trochanteric bursitis?

A

Pain - point of tenderness in the lateral hip

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18
Q

What will come up on examination of trochanteric bursitis?

A

LOOK - Scars from previous surgery, muscle wasting
FEEL - tenderness at greater tuberosity
MOVE - worst pain in active abduction

19
Q

What investigations should be done into trochanteric bursitis?

A

X-Ray
MRI - soft tissue and fluid
Ultrasound

20
Q

How is trochanteric bursitis treated?

A 
NSAIDs
Relative rest/activity modification
Physiotherapy
Corticosteroid injection
Rarely surgical bursectomy
21
Q

What is done in physiotherapy for trochanteric bursitis?

A

Correct posture
Stretching
Strengthen muscles around the joint

22
Q

What is avascular necrosis?

A

Death of bone due to loss of blood supply

23
Q

What trauma can cause avascular necrosis?

A

Irradiation
Fracture
Dislocation
Iatrogenic

24
Q

What systemic issues can cause avascular necrosis?

A 
Idiopathic
Hypercoagulable states
Steroids
Haematological - sickle cell, lymphoma, leukaemia
Caisson's disease
Alcoholism
25
Q

What are symptoms of avascular necrosis?

A

Insidious onset of groin pain
Pain with stairs, walking uphill, impact activities
Limp

26
Q

What will you find on examination of avascular necrosis?

A

Largely normal

May replicate early arthritis - reduced range of motion, stiff joint

27
Q

How is avascular necrosis treated?

A 
Reduce weight bearing
NSAIDs
Bisphosphonates for early avascular necrosis
Anticoagulants
Physiotherapy
Core decompression
28
Q

What is femoroacetabular impingement?

A

Impingement of femoral neck against anterior edge of acetabulum

29
Q

What is pincer femoroacetabular impingement?

A

Acetabulum based impingement usually in active females - abnormal acetabulum leads to anterosuperior acetabular rim overhang and acetabular protrusion

30
Q

What are associated injuries with femoroacetabular impingement?

A

Labral degeneration and tears
Cartilage damage and flap tears
Secondary hip osteoarthritis

31
Q

How does femoroacetabular impingement present?

A

Groin pain worse with flexion

Mechanical symptoms - block to movement, pain getting out of chairs

32
Q

How is femoroacetabular impingement diagnosed in examination?

A

Reduced flexion and internal rotation

Positive FADIR test

33
Q

What is the FADIR test?

A

Flexion
ADuction
Internal Rotation

34
Q

What investigations can be done for femoroacetabular impingement?

A

X-ray for bony pathology

MRI for associated conditions - labral tears and articular cartilage damage

35
Q

What is non-operative treatment for femoroacetabular impingement?

A

Activity modification
NSAIDs
Physiotherapy

36
Q

What is done in physiotherapy for femoroacetabular impingement?

A

Correct posture

Strengthen muscles around joint

37
Q

What are operative treatments for femoroacetabular impingement?

A

Arthroscopy

Open surgery

38
Q

What can cause labral tear?

A 
Femoroacetabular impingement
Trauma
Osteoarthritis
Dysplasia
Collagen diseases
39
Q

How does labral tear present?

A

Groin or hip pain
Snapping sensation
Jamming or locking

40
Q

How is labral tear examined?

A

Positive FABER tesr

41
Q

What is the FABER test?

A

Flexion
ABduction
External Rotation

42
Q

How is labral tear investigated?

A

X-ray for osteoarthritis or dysplasia
MRI arthrogram - 92% sensitive
Diagnostic injection

43
Q

What are treatment options for labral tear?

A

Non-operative - acitivity modification, NSAIDs, physio, steroid injection
Operative - arthroscopy

MSK (30 decks)

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